McArthur Tatum A, Narducci Carl A, Lander Phillip H, Lopez-Ben Robert
Department of Radiology, The University of Colorado, Musculoskeletal Radiology, Aurora, CO.
Department of Radiology, The University of Alabama at Birminghamm, Musculoskeletal Radiology, Birmingham, AL.
Curr Probl Diagn Radiol. 2017 Jul-Aug;46(4):282-287. doi: 10.1067/j.cpradiol.2016.11.007. Epub 2016 Nov 10.
Painful osseous metastases are a common problem in patients with malignancy, and they can be associated with significant morbidity owing to immobility, pain, pathologic fracture, or neurovascular compromise or all of these. We retrospectively evaluated pain levels and tumor enhancement in patients who underwent palliative percutaneous cryoablation for painful bone metastasis.
In this institutional review board-approved, health insurance portability and accountability act-compliant study, we retrospectively searched our department׳s picture archiving system for patients who underwent computed tomography (CT)-guided percutaneous cryoablation for treatment of painful metastatic osseous disease over a 6-year period (1/1/2005-12/31/2011). The preprocedure and postprocedure images and imaging reports, primary tumor type, CT-guided cryoablation procedure details, treated tumor response, immediate and 3-month postprocedure complications, reported pain response to cryoablation, postprocedural tumor imaging characteristics, and imaging response of noncryoablated systemically treated metastatic lesions were reviewed in patients with metastatic osseous disease who underwent cryoablation.
All 16 patients reported improvement in pain within 1 week after the procedure and at 3-month clinical follow-up. A total of 6.2% had tumor growth and 93.8% had tumor arrest or shrinkage on follow-up CT, although all study patients had progression of noncryoablated metastases at other sites despite systemic therapy. A total of 62.5% of patients with posttreatment contrasted CT demonstrated marginal enhancement at the ablation site, although only single patient had interval growth.
Most of our patients had tumor arrest or shrinkage on follow-up imaging, despite progression of noncryoablated metastases treated with preprocedure and postprocedure systemic therapy. Radiation therapy, chemotherapy, and analgesics have a moderate failure rate and require repeat treatments where quality of life is the foremost objective. CT-guided cryoablation is a safe palliative treatment to reduce pain in patients with painful osseous metastatic disease, achieve effective local tumor control, and in some cases, provide a curative option for a target lesion.
疼痛性骨转移是恶性肿瘤患者的常见问题，由于活动受限、疼痛、病理性骨折或神经血管受压或所有这些因素，它们可能与显著的发病率相关。我们回顾性评估了因疼痛性骨转移接受姑息性经皮冷冻消融治疗的患者的疼痛程度和肿瘤强化情况。
在这项经机构审查委员会批准、符合《健康保险流通与责任法案》的研究中，我们回顾性地在本部门的图像存档系统中搜索在6年期间（2005年1月1日至2011年12月31日）因疼痛性转移性骨病接受计算机断层扫描（CT）引导下经皮冷冻消融治疗的患者。对接受冷冻消融的转移性骨病患者的术前和术后图像及影像报告、原发肿瘤类型、CT引导下冷冻消融手术细节、治疗后的肿瘤反应、术后即刻和3个月的并发症、报告的冷冻消融疼痛反应、术后肿瘤影像特征以及未接受冷冻消融的全身治疗转移性病变的影像反应进行了回顾。
所有16例患者在术后1周内及3个月临床随访时均报告疼痛有所改善。尽管所有研究患者在接受全身治疗的情况下，其他部位未接受冷冻消融的转移灶仍有进展，但共有6.2%的患者出现肿瘤生长，93.8%的患者在随访CT上肿瘤停滞或缩小。共有62.5%接受治疗后增强CT检查的患者在消融部位显示边缘强化，尽管只有1例患者有间隔期生长。
尽管术前和术后全身治疗未能使未接受冷冻消融的转移灶得到控制，但我们的大多数患者在随访影像上肿瘤停滞或缩小。放射治疗、化疗和镇痛药有一定的失败率，在以生活质量为首要目标时需要重复治疗。CT引导下冷冻消融是一种安全的姑息治疗方法，可减轻疼痛性骨转移性疾病患者的疼痛，实现有效的局部肿瘤控制，在某些情况下，为靶病变提供一种治愈性选择。
